Role of direct surgery for arteriovenous malformations in the multi-modal treatment era

Recently, recommendations of managing cerebral arteriovenous malformations（AVMs）with multi-modal treatment in conjunction with the completion of the ARUBA study have significantly reduced the number of direct surgeries for AVMs. Nevertheless, favorable safety profiles and cure rates can still be achieved with appropriate patient selection and judicious use of intraoperative support devices. In this arti-cle, we present our experience in the direct surgery of AVMs in the present setting, and discuss the cen-tral role of surgery to promote treatment outcomes. In addition, it is important to utilize practice‒based data to establish indication criteria that reflects surgical outcomes.